The Significance of Stone Culture in the Incidence of Sepsis: Results from a Prospective, Multicenter Study on Infections Post Flexible UreteroreNescopy (I-FUN) and Laser Lithotripsy for Renal Stones.

Autor: Castellani D; Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Brocca C; Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., De Stefano V; Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Mazzon G; Urology Unit, ULSS, Bassano del Grappa, Italy., Celia A; Urology Unit, ULSS, Bassano del Grappa, Italy., Bosio A; Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy., Bertello G; Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy., Alessandria E; Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy., Cormio L; Andrology and Urology Unit, 'L. Bonomo' Hospital, Andria, Italy.; School of Urology, University of Foggia, Foggia, Italy., Ratnayake R; Andrology and Urology Unit, 'L. Bonomo' Hospital, Andria, Italy.; School of Urology, University of Foggia, Foggia, Italy., Vismara Fugini A; Urology Unit, Fondazione Poliambulanza Hospital, Brescia, Italy., Morena T; Urology Unit, Fondazione Poliambulanza Hospital, Brescia, Italy., Tanidir Y; Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Sener TE; Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Choong S; Institute of Urology, University College Hospitals of London, London, United Kingdom., Ferretti S; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Pescuma A; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Micali S; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Pavan N; Department of Surgical, Oncological and Stomatological Sciences, Urology Clinic, University of Palermo, Palermo, Italy., Simonato A; Department of Surgical, Oncological and Stomatological Sciences, Urology Clinic, University of Palermo, Palermo, Italy., Gauhar V; Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Galosi AB; Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
Jazyk: angličtina
Zdroj: Journal of endourology [J Endourol] 2024 Sep; Vol. 38 (9), pp. 948-955. Date of Electronic Publication: 2024 Jul 01.
DOI: 10.1089/end.2024.0182
Abstrakt: Objective: Sepsis is the most serious complication of flexible ureteroscopy (F-URS) and laser lithotripsy. We assessed the influence of positive stone culture (SC) on major infectious complications (sepsis, septic shock). Methods: This prospective study enrolled adult patients deemed suitable for F-URS and laser lithotripsy from nine centers (January 2022-August 2023). Inclusion criteria were as follows: kidney stone(s), preoperative midstream urine culture (MSUC), stone(s) assessed at computed tomography scan, and SC. Exclusion criteria were as follows: bilateral procedures, ureteral stones, and children. Group 1 included patients with sterile SC. Group 2 included patients with positive SC. Data are presented as median (interquartile range). A multivariable logistic regression analysis was performed to evaluate factors associated with having a positive SC. Results: In total, 293 patients were included. Median age was 51.0 (24) years. There were 167 (57.0%) males. Group 2 included 32 (2.5%) patients. Group 2 patients were significantly older [75.0 (14) vs 51.0 (23) years, p = 0.02]. Stone features were similar. Major infectious complications were higher in Group 2 (15.6% vs 0.4%). One patient died because of sepsis in Group 2. Two out of 6 (33.3%) patients with major infectious complications had the same pathogen in MSUC and SC. In the multivariable regression analysis, diabetes (OR 3.23), symptomatic urinary infections within 3 months before operation (OR 4.82) and preoperative stent/nephrostomy (OR 2.92) were factors significantly associated with higher odds of positive SC. Conclusions: Patients with positive SC have a higher incidence of major infectious complications after F-URS lithotripsy. SC should be performed whenever feasible because there is a poor correlation between MSUC and SC.
Databáze: MEDLINE
Externí odkaz: